The Difference Between - ohioassistedliving.org · 6 © Teepa Snow, Positive Approach, LLC –to be...
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1 © Teepa Snow, Positive Approach, LLC – to be reused only with permission. © Teepa Snow, Positive Approach, LLC – to be reused only with permission. Handouts are intended for personal use only. Any copyrighted materials or DVD content from PositiveApproach, LLC (Teepa Snow) may be used for personal educational purposes only. This material may not be copied, sold or commercially exploited, and shall be used solely by the requesting individual. Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach® to Care Any redistribution or duplication, in whole or in part, is strictly prohibited, without the expressed written consent of Teepa Snow and Positive Approach, LLC © Teepa Snow, Positive Approach, LLC – to be reused only with permission. The Difference Between Confrontational and Supportive Communication
Transcript of The Difference Between - ohioassistedliving.org · 6 © Teepa Snow, Positive Approach, LLC –to be...
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Handouts are intended for personal use only.Any copyrighted materials or DVD
content from Positive Approach, LLC (Teepa Snow) may be used for personal
educational purposes only. This material may not be copied, sold or
commercially exploited, and shall be used solely by the requesting individual.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach® to Care
Any redistribution or duplication, in whole or in part, is strictly prohibited,
without the expressed written consent of Teepa Snow and
Positive Approach, LLC
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
The Difference Between
Confrontational and
Supportive
Communication
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Essentials for Communication:
What Helps?
What Hurts?
What Matters Most?
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Getting The Person to DO
Something:
Form a relationship FIRST,
then work on task attempt!
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Connect:
- 1st Visually
- 2nd Verbally
- 3rd Physically
- 4th Emotionally
- 5th Individually, spiritually
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Normal Brain Alzheimers BrainUsed with permission from Alzheimers:The Broken Brain, 1999 University of Alabama
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Hippocampus:
Learning and
Memory Center
BIG CHANGE
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Understanding Language – BIG CHANGE
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Hearing Sound – Not Changed
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Sensory Strip
Motor Strip
White Matter
Connections
BIG CHANGES
Formal Speech
and Language
Center
HUGE CHANGES
Automatic
Speech
Rhythm –
Music
Expletives
PRESERVED
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Executive
Control
Center:
Emotions
Behavior
Judgment
Reasoning
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Vision Center – BIG CHANGES
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To Connect:
Use the Positive Physical
Approach™
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Positive Physical Approach™:
-Pause at edge of public space (6 feet)
-Gesture and greet by name
-Offer your hand and make eye contact
-Approach slowly within visual range
-Shake hands and then maintain Hand-under-Hand®
-Move to the side
-Get to eye level and respect intimate space
-Wait for acknowledgement
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Hand-under-Hand®:Protects aging, thin, fragile, forearm skin
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To Connect:
- Use the PPA™ to get started
- Make a VISUAL connection
-Look interested and friendly
- Make a VERBAL connection
-Sound enthusiastic, keep responses short
- Make a PHYSICAL connection
-Hold Hand-under-Hand®, or use flat open
hand on forearm or knee
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Then, Connect Emotionally:
- Make a connection
-Offer your name: “I’m (name) and you are…?”
-Offer a shared background: “I’m from (place) and you’re
from…?”
-Offer a positive personal comment: “You look great in
that!” or “I love that color on you.”
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Connecting Emotionally:- Identify common interest
-Say something nice about the person or their place
-Share something about yourself and encourage the
person to share back
-Follow their lead and listen actively
-Use some of their words back to keep the flow going
-Remember it’s often the ‘FIRST TIME’ for them, so
expect repeats
-Use the phrase “Tell me about…”
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To Communicate:
Just Having a Conversation-The more you KNOW, the better it will GO
-Take it slow and go with the flow
-Later in the disease:
-Use props or objects
-Consider parallel engagement at first
-Look at the ‘thing,’ be interested, share it
- Talk less, wait longer, take turns
-Cover, don’t confront when you aren’t getting their words and just enjoy the exchange
-Use automatic speech and social patterns to start interactions
-Keep words short and emphasize the VISUAL
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Then, Get it Going!
- Give Simple and SHORT Information
- Offer concrete CHOICES
- Ask for HELP
- Ask the person to TRY
- Break the TASK DOWN to single steps at a time
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Give Simple Information:
- Use Visual cue (gesture/point) combined with a Verbal cue:
-“Its about time for… “
-“Lets go this way…”
-“Here are your socks…”
- Don’t ask questions you don’t want to hear the answer to!
- Acknowledge the response/reaction to your information
- Limit your words and keep it simple
- WAIT!!!!
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Do:
- Go with the flow
- Use supportive communication techniques
-Use objects and the environment
-Give examples
-Use gestures and pointing
-Acknowledge and accept emotions
-Use empathy and validation
-Use familiar phrases or known interests
-Respect values and beliefs and avoid the negative
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DON’T:- Try to control the flow
-Give up reality orientation and BIG lies
-Do not correct errors
-Offer info if asked, monitoring the
emotional state
- Try to stop the flow
-Don’t reject topics
-Don’t try to distract until you are well
connected
-Keep visual cues positive
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To Communicate
When They’re Distressed:
First - Connect
Then - Use Supportive Communication
Finally – Move Together to Something New
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Be a Detective, Not a Judge!
Try to figure out WHAT is being
communicated:
• Words
• Thoughts
• Actions
• Needs
• Beliefs
DON’T assume or presume
DON’T discount the message
because of HOW it is delivered
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Top Ten Unmet Needs:
Hungry or thirsty
Tired or over-energized
Elimination: need to/did
Temperature: too hot/cold
IN PAIN!!!
• Joints - skeleton
• Inside systems (head, chest, gut, output)
• Creases or folds of skin
• Surfaces that contact other surfaces
Angry
Sad
Lonely
Scared
Bored
Unmet Physical Needs: Unmet Emotional Needs:
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To Communicate and Figure It Out:
CONNECT:
• Visually
• Verbally
• Physically
• Emotionally
• Spiritually
HOW?
• PPA™
• Supportive Communication
SUPPORTIVE COMMUNICATION:
• Empathy
• Validation
• Exploration
• Acknowledgement
MOVE FORWARD:
• New words
• New place
• New Activity/Focus
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To Connect When They’re Distressed:
- Send visual signal of connection:
-LOOK CONCERNED
- Send a verbal signal of connection:
-Use the RIGHT TONE OF VOICE
- Send a physical signal of connection:
-Give a light SQUEEZE or SANDWICH the hand
-Offer a OPEN PALM on shoulder or back
-Offer a HUG if the person is seeking more contact
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What is Supportive Communication?
• Repeat a few of their words with a question at the end
• Avoid confrontational questions
• Use just a few words
• Go slow
• Use examples
• Fill in the blanks
• LISTEN, then offer empathy:
“Sounds like…” or “Seems like…” or “Looks like…”
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More Supportive Communication:
• Validate their emotions
• Early Stage: “It’s really (label emotion) to have this
happen” or “I’m so sorry this is happening to you!”
• Mid Stage: Repeat their words with emotion:
-Listen for added information, ideas, thoughts
-Explore the new info by watching and listening
-Late Stage: Check out the whole body:
-Face, posture, movement, gestures, touching, looking
-Look for NEED under the words or actions
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Once You’re Connected and
Communicating:
Move FORWARD
• ADD new words
• MOVE to a new place or
location
• Add a NEW Activity
Early Stage: Redirection
• Same subject, different
focus
Later Stage: Distraction
• Different subject,
unrelated BUT enjoyed
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For ALL Communication:
If what you are trying is NOT working:
- STOP
- Back off
- Think it through, then:
- Re-approach
- Try something slightly different
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How You Look At Dementia Matters!
- It is NOT all about loss
- It is NOT “untreatable”
- It is NOT unpredictable
- Behaviors DON’T come out of nowhere
- Dementia DOESN’T just affect the person
with the disease – it impacts all of us
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The GEMS®
Sapphires
Diamonds
Emeralds
Ambers
Rubies
Pearls
Until we begin to the see the beauty and value
in what the person is at this point in time, we
will never care for them as we should
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Why Use GEMS®?
- Uses familiar concepts to talk about a difficult subject
- Focuses on what is valued rather than on a number or
amount of ‘decline’
- Like people, gems are precious and unique, with
common characteristics
- Allow to us to get beyond the words dementia and
Alzheimer’s
- Opens the door to talking about changes
- Allow us to speak in a “code” to protect dignity
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Sapphires- Us on a good day
- Clear and true to ourselves
- May feel ‘blue’ over changes
- Some are ‘stars’ and some are not
- Can typically choose our behavior
- Can connect ABCs and make contracts
- May have other health issues that affect behaviors
- Recognize life experiences, achievements and values
- Can follow written info and hold onto it
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Diamonds
-Sharp, hard, rigid, inflexible, can cut
-Many facets, still often clear, can really shine
-Are usually either Joiners or Loners
-Can complete personal care in familiar place
-Usually can follow simple prompted schedules
-Misplaces things and can’t find them
-Resents takeover or bossiness
-Notices other people’s misbehavior and mistakes
-Vary in lack of self-awareness
-Use old routines and habits
-Control important roles and territories, use refusals
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Emeralds
-Changing color
-Not as clear or sharp, more vague
-On the go, need to ‘do’
-Flaws may be hidden
-Time traveling is common
-Are usually Doers or Supervisors
-Do what is seen, but miss what is not seen
-Must be in control, but not able to do it correctly
-Do tasks over and over, or not at all
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Ambers-Amber Alert- Caution!
-Caught in a moment
-All about sensation and sensory tolerance, easily over or
under stimulated
-May be private and quiet or public and noisy
-No safety awareness
-Ego-centric
-LOTS of touching, handling, tasting, mouthing,
manipulating
-Explorers, get into things, invade space of others
-Do what they like and avoid what they do not like
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Rubies:-Hidden depths
-Major loss of fine motor finger and mouth skills, but
can do gross motor skills like walking, rolling, rocking
-Comprehension and speech halted
-Wake-sleep patterns very disturbed
-Balance, coordination, and movement losses
-Eating and drinking patterns may change
-Tends toward movement unless asleep
-Follows gross demonstration and big gestures for actions
-Limited visual awareness
-Major sensory changes
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Pearls:-Hidden in a shell: still, quiet, easily lost
-Beautiful and layered
-Spends much time asleep or unaware
-Unable to move, bed or chair bound, frequently fall forward or to side
-May cry out or mumble often, increases vocalizations with distress
-Can be difficult to calm, hard to connect
-Knows familiar from unfamiliar
-Primitive reflexes
-The end of the journey is near, multiple systems are failing
-Connections between the physical and sensory world are less strong
but we are often the bridge
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Progression
of the
Condition
To the tune of ‘This Old Man’
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SAPPHIRE true, you and me,
The choice is ours, and we are free
To change our habits, to read, and think and do,
We’re flexible, we think it through!
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DIAMOND bright, share with me,
Right before, where I can be,
I need routine and different things to do,
Don’t forget, I get to CHOOSE!
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EMERALD – GO, I like to DO,
I make mistakes, but I am through!
Show me only one step at a time,
Break it down and I’ll be fine.
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AMBER – HEY! I touch and feel,
I work my fingers, rarely still.
I can do things if I copy you,
What I need is what I do!
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RUBY – skill – it just won’t go,
Changing something must go SLOW
Use your body to show me what you need,
Guide, don’t force me, don’t use speed!
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Now a PEARL, I’m near the end,
But I still feel things through my skin,
Keep your handling always firm and slow,
Use your voice to calm my soul.
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Personal Preferences Matter
- We like what we like!
- With dementia, the ‘likes’ can change
- Old preferences will need to be revisited
- The challenge is to HONOR what is
important BUT change what is needed
- Our willingness to meet the person’s
changing needs is essential
- Changes are made harder by our sense
of LOSS and GRIEF
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Some Personal Preferences:
- Appearance
- Behaviors
- Language
- Daily routines
- Foods and drinks
- Music
- Touch, textures, noise, space
- Worship and spiritual practices
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Personality Traits:
Who are you?
- Introvert - Extrovert
- Lots of Details - Big Picture Only
- Logical - Emotional
- Planning Ahead – Being in the Moment
Who is the person you are trying to help?
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Take Time for YOU so you can
be a better care partner!
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BREATHE!!!Take a deep breath in
BLOW it all the way out
Take another breath in
BLOW it out
Take one final breath in AND
SING IT OUT….
Feel what happened to you
Look at what happened to the people around you
Think about how and when you might do this
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Let Go:
How it “used to be”
How it “should be”
How you “should be”
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Identify:
- What you’re good at…and what you’re not
- Who can help…and how they can help
- What really matters
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What you leave behind is not
what is engraved in stone
monuments,
but what is woven into the
lives of others
20
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This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other applicable international, federal, state and
local laws, with ALL rights reserved. No part of this may be copied, or changed in any format, sold, or used in any way other than what is outlined within this under any
circumstances without express permission from Positive Approach to Care.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach to Care
DISCLAIMER
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